Results of management of cervical lymph node metastases in differentiated thyroid carcinoma: Experience in an upper middle-income country.

Abstract

e18158 Background: Thyroid cancer frequently produces metastases in the central compartment of the neck, followed by the lateral lymph node compartments. This study aims to characterize lymph node metastases in patients with differentiated thyroid carcinoma (DTC) treated at a cancer center in Guatemala. Methods: A review of clinical records from 2019 to 2023 of patients diagnosed with DTC with clinically positive lymph nodes treated at the Guatemala Cancer Institute, was conducted. Demographic, clinical, and pathological data were collected for analysis. Our study considered the ideal number of lymph nodes as: ≥19 in the lateral compartment and ≥6 in the central compartment. Adequate follow-up was established as patients receiving radioactive iodine (RAI) and who have a subsequent evaluation. Results: 72 patients were analyzed, mean age of 49 years, 81% of whom were women. Types of dissection were type III (64%), II (29%) and I (7%). Of these, 41 dissections were performed on the right side, 35 on the left and 6 in the central compartment. It is worth mentioning that 16 patients (22%) had bilateral dissections. Regarding the lymph nodes removed, most of the lateral dissections had less than 19 nodes, while in the central compartment, 45% of the cases had less than 6 nodes. The predominant histology was papillary carcinoma (81%), and 58% of the tumors were multifocal. Lymphovascular permeation was observed in 83% of the cases, perineural invasion in 39% and capsular infiltration in 69%. Only 53% of the patients received adequate follow-up. Conclusions: In this study, contrary to what has been reported in the literature, the patients treated at our institute presented greater involvement of the lateral compartments. Most lymph node dissections were below ideal values, probably due to a lack of expertise in surgical techniques considering the low number of procedures performed annually at the center, approximately 14 per year. An aggressive profile was observed, with high rates of multifocality, lymphovascular permeation and capsular infiltration. Inadequate follow-up may be related to the lack of RAI at our institution and socioeconomic factors. Characteristics of patients. Characteristics No. Age (mean) 18-79 (49) Gender  Male 14 (19%)  Female 58 (81%) Type of Dissection  I 5 (7%)  II 21 (29%)  III 46 (64%) Side*  Right 41  Left 35  Central 6 Harvested lymph nodes  Right lateral ≥19 6 (15%)  Right lateral <19 35 (85%)  Left lateral ≥19 8 (23%)  Left lateral <19 27 (77%)  Central ≥6 6 (55%)  Centro <6 5 (45%) Histology  Papillary 58 (81%)  Follicular 14 (19%) Focality  Multifocal 42 (58%)  Unifocal 30 (42%) Lymphovascular permeation  Present 60 (83%)  Absent 12 (17%) Perineural invasion  Present 28 (39%)  Absent 44 (61%) Infiltration of a capsule  Present 28 (39%)  Absent 44 (61%) Follow-up  Adequate 38 (53%)  Not adequate 33 (46%)  Sent to other center 1 (1%) *Some case had bilateral dissection.